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Research


This section provides links to published resources regarding the non-technical skills for surgeons (NOTSS) behavior rating tool.

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Research


This section provides links to published resources regarding the non-technical skills for surgeons (NOTSS) behavior rating tool.

Non-Technical skills for surgeons (NOTSS)

NOTSS was developed by a multidisciplinary team of psychologists, surgeons and an anaesthetist under funding from the Royal College of Surgeons of Edinburgh and National Health Service Education for Scotland (NES) starting in 2003. Psychologists at the University of Aberdeen in Scotland led the development. A systematic process was used to develop NOTSS, involving subject matter experts (consultant surgeons) and replicating methods of systems design used for developing methods of assessing behavior in other high demand professions such as civil aviation and nuclear power. An adapted model of systems design and set of design guidelines was used to assist with design and evaluation of the system. Current work is on implementation and adaption to local surgical contexts.

Relevant papers and resources are listed below. 

 

NOTSS Assessment Tool


What are Non-Technical Skills (NTS)? 

Non-technical skills (NTS) reflect cognitive (e.g. situation awareness) and interpersonal skills (e.g. communication) that complement technical expertise and knowledge. NTS underpin an individual's ability to anticipate, identify, and mitigate error. (Yule et al. World J Surg 2008, 32:548-556)

 

Background:

Studies have shown the lack and dysfunction of these skills under adverse events are the basis of many technical errors. In response, high-risk industries such as civil aviation, offshore oil exploration, and nuclear power generation, resulted in the development of training and assessment in non-technical skills; these trainings are referred to as crew resource management (CRM) training. Behavior rating systems were developed from CRM trainings to formally assess non-technical skills and from these methods the health care industry evolved. (Yule & Paterson-Brown Surg Clin N Am 2012, 92:37-50)


WHAT ARE BEHAVIORAL MARKERS?

are observable, non-technical behaviors structured typically into a set of categories used to frame training and evaluation of non-technical skills in order to improve safety and inefficiency (Klampfer et al. GIHRE 2001). A behavioral marker system is a rating scale comprising of a skills taxonomy with examples of good and poor behavioral markers partnered to each skill. Behavioral marker systems should be context-specific reflecting the operational environment, transparent and reliable for effective assessment (Yule et al Med Ed 2006;40:1098-1104).  


HOW ARE BEHAVIORAL MARKERS DEVELOPED?

A behavioral marker system is derived from analysis of empirical data that contributes to superior or substandard outcomes in a specific industry (Klampfer et al. GIHRE 2001).

EXAMPLES OF EXISTING TOOLS DEVELOPED BASED ON NON-TECHNICAL SKILLS


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NTS Literature


Relevant papers and resources are listed below

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NTS Literature


Relevant papers and resources are listed below

 (i)            NOTSS Evaluation 

Crossley J, Marriott J, Purdie H, Beard JD. 2011. Prospective observational study to evaluate NOTSS (Non-Technical Skills for Surgeons) for assessing trainees' non-technical performance in the operating theatre. British Journal of Surgery, 98, 1010-1020. PubMED PMID: 21480195

Sharma B, Mishra A, Aggarwal R, Grantcharov TP. 2011. Non-technical skills assessment in surgery. Surgical oncology, 20, 169-77. PubMed PMID: 21129950

Yule S, Rowley D, Flin R, Maran N, Youngson GG, Duncan J, Paterson‐Brown S. 2009. Experience matters: Comparing novice and expert ratings of non‐technical skills using the NOTSS system. ANZ Journal of Surgery, 79, 154‐160. PubMed PMID: 19317781

Yule S, Flin R, Maran N, Rowley DR, Youngson GG, Paterson-Brown S. 2008. Surgeons' non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. World Journal of Surgery, 32, 548-556. PubMed PMID: 18259809 

Arora S, Miskovic D, Hull L, Moorthy K, Aggarwal R, Johannsson H, et al. 2011. Self vs expert assessment of technical and non-technical skills in high fidelity simulation. The American Journal of Surgery, 202, 500-6. PubMed PMID: 21943950
 

 

(ii)          NOTSS implementation

Yule S, Smink D. 2013. Competency-based surgical care: Nontechnical skills in surgery. ACS Surgery: Principles and Practice. 

Kissane-Lee N, Fiedler A, Mazer L, Pozner C, Smink D, Yule S. 2013. Coaching Surgical Residents on Leadership in a Simulated Operating Room: Randomized Controlled Trial. Amercian College of Surgeons Clinical Congress.  

Dedy N, Zevin B, Bonrath E, Grantcharov T. 2013. Non-technical skills of surgery residents: does experiential learning lead to competence? American College of Surgeons Clinical Congress, Washington, DC. 

Yule S, Paterson-Brown S. 2012. Surgeons' non-technical skills. Surg Clin North Am, 92, 37-50. PubMed PMID: 22269259. Epub 2012/01/25. eng. 

Dickinson I, Watters D, Graham I, Montgomery P, Collins J. 2009. Guide to the Assessment of Competence and Performance in Practicing Surgeons. ANZ journal of surgery, 79, 198-204. PubMed PMID: 19317789

Yule S, Flin R, Rowley D, Mitchell A, Youngson GG, Maran N, Paterson-Brown S. 2008. Debriefing surgical trainees on non-technical skills (NOTSS). Cognition, Technology & Work, 10, 265-274. PubMed PMID: 18259809

Flin R, Yule S, Paterson-Brown S, Maran N, Rowley DR, Youngson GG. 2007. Teaching surgeons about non-technical skills. The Surgeon, 5, 86-89. PubMed PMID: 17450689

 

(iii)          Adaptions of NOTSS

Pugh C, Cohen E, Kwan C, Cannon-Bowers J. 2014. A comparative assessment and gap analysis of commonly used team rating scales. Journal of Surgical Research, 190, 445-50. PubMed PMID: 24880200

Spanager L, Beier-Holgersen R, Dieckmann P, Konge L, Rosenberg J, Oestergaard D. 2013. Reliable assessment of general surgeons’ non-technical skills based on video-recordings of patient simulated scenarios. American Journal of Surgery, 206, 810-7. PubMed PMID: 23871323

Spanager L, Lyk-Jensen H, Dieckmann P, Wettergren A, Rosenberg J, Ostergaard D. 2012. Customization of a tool to assess Danish surgeons’ non-technical skills in the operating room. Danish Medical Journal, 59, 1-6. PubMed PMID: 23171747

Spanager L, Lyk-Jensen H, Dieckmann P, Wettergren A, Rosenberg J, Ostergaard D. 2012. Customization of a tool to assess Danish surgeons’ non-technical skills in the operating room. Danish Medical Journal, 59, 1-6. 

Lin Y, Scott JW, Mutabazi Z, Smink D, Yule S, Riviello R, Ntakdyiruta G. Strong support for a context-specific curriculum on non-technical skills for surgeons (NOTSS). East and Central African Journal of Surgery 2016:21(3):3-5

Scott J, Lin Y, Ntakiyiruta G, Mutabazi ZA, Davis WA, Morris MA, Smink DS, Riviello R, Yule S. Contextual Challenges to Safe Surgery in a Resource-Limited Setting: A Multicenter, Multiprofessional Qualitative Study. Annals of Surgery (2017, in press Mar 2). doi: 10.1097/SLA.0000000000002193.